Anxiety Defined Pathogenesis Patho-physiology Classifications of Anxiety disorders Symptoms Diagnosis Treatments and Management Complications of anxiety Clinical case
Anxiety is a feeling of apprehension or fear. Fear is a normal reaction towards a known or external source Anxiety is fright associated with an unknown source of danger that is inadequate to account for the associated symptoms. Anxiety disorders are a group of psychiatric conditions that involve excessive anxiety.
Early onset- children, teens or early twenties 2% of population affected with a 2:1 female : male ratio Most common mental illness in the U.S. with 19 million of the adult (ages 18-54) U.S. population affected. Anxiety is highly treatable (up to 90% of cases), but only one- third of those who suffer from it receive treatment People with an anxiety disorder are 3-5 times more likely to go to the doctor and six times more likely to be hospitalized for psychiatric disorders than non-sufferers. Depression often accompanies anxiety disorders
Cause : Unknown Predisposing factors include: Genetics Gender: Females >Males Brain biochemistry Overactive "fight or flight" response Life circumstances Personality Certain drugs
Biological basis: Neurotransmitters Increased activity of Norepinephrine Low levels of Serotonin and GABA, a neurotransmitter that reduces activity in the central nervous system, contribute to anxiety Neural and brain area involvement Locus ceruleus (site of noradrenergic neurons) Raphe nucleus (site of serotonergic neurons) Caudate nucleus (especially in OCD) Temporal and Frontal cortexes Organic causes of symptoms Excess caffeine intake Substance abuse Hyperthyroidism, Vit B 12 deficiency Phaechromacytoma
Panic disorder (PD) (with or without agoraphobia- specific anxiety of place or situation) Phobias (specific and social) Obsessive compulsive disorder (OCD) Generalized anxiety disorder (GAD) Post traumatic stress disorder (PTSD) Acute stress disorder (ASD)
The abrupt onset of an episode of intense fear or discomfort, which peaks in approximately 10 minutes, and includes at least four of the following symptoms: There are three types of Panic Attacks: 1. Unexpected - the attack "comes out of the blue" without warning and for no discernible reason. 2. Situational - situations in which an individual always has an attack, for example, upon entering a tunnel. 3. Situationally Predisposed - situations in which an individual is likely to have a Panic Attack, but does not always have one. An example of this would be an individual who sometimes has attacks while driving. A feeling of imminent danger or doom The need to escape Palpitations, Sweating, Trembling SOB or a smothering feeling Chest pain or discomfort Nausea or abdominal discomfort Dizziness or lightheadedness A fear of losing control or "going crazy" Chills or hot flushes
Characterized by uncontrollable obsessions and compulsions which the sufferer usually recognizes as being excessive or unreasonable. Obsessions are recurring thoughts or impulses that are intrusive or inappropriate and cause the sufferer anxiety Compulsions are repetitive behaviors or rituals performed to neutralize the anxiety caused by obsessive thoughts and provide temporary relief. In order for OCD to be diagnosed, the obsessions and/or compulsions must take up a considerable amount of the sufferers time, at least one hour every day, and interfere with normal routines.
Excessive uncontrollable worry about everyday things. This constant worry affects daily functioning and can cause physical symptoms. For example: like job, finances, health of both self and family etc. The intensity, duration and frequency of the worry are disproportionate to the issue GAD can occur with other anxiety disorders, depressive disorders, or substance abuse.
Exposure to traumas such as a serious accident, a natural disaster, or criminal assault can result in PTSD. When the aftermath of a traumatic experience interferes with normal functioning, the person may be suffering from PTSD. Symptoms of PTSD are: Reexperiencing the event Avoidance behavior A general numbness and loss of interest in surroundings; Hypersensitivity, including: inability to sleep, anxious feelings, overactive startle response, hypervigilance, irritability and outbursts of anger.
Phobias are an intense fear of social/specific situations. This fear arises when the individual believes that they may be judged, scrutinized or humiliated by others. For example: public speaking talking with people in authority dating and developing close relationships making a phone call or answering the phone interviewing attending and participating in class speaking with strangers meeting new people eating, drinking, or writing in public using public bathrooms driving shopping Individuals are acutely aware of the physical doing Extreme cases may lead to a full blown panic attack.
Anxiety is an emotion often accompanied by various physical symptoms, including: Twitching or trembling Muscle tension Headaches Sweating Dry mouth Difficulty swallowing Abdominal pain (may be the only symptom of stress especially in a child)
Anxiety disorders can lead to, or worsen, other mental and physical health conditions, such as: Depression (which often occurs with anxiety disorder) Substance abuse Trouble sleeping (insomnia) Digestive or bowel problems Headaches Suicide Poor quality of life
Diagnostic evaluation Coexisting conditions (depression, alcohol or substance abuse). Diagnosis is based on: The intensity and duration of symptoms Any problems with daily functioning caused by the symptoms Observation of the patient's attitude and behavior. No specific lab tests for diagnosing anxiety disorders Determine if symptoms and degree of dysfunction indicate a specific anxiety disorder.
1. Panic disorder: sudden onset of symptoms: Lasting 10 – 30 mins Intense episodes twice a week Cardiac & respiratory symptoms Attacks induced by sodium lactate or CO 2 Genetic component Agoraphobia (fear of public or open places) 2.Obsessive – compulsive disorder (OCD) Recurring intrusive feelings, thoughts or images that may cause anxiety (obsessions) Relieved by performing repetitive actions (compulsions) 3. Generalized anxiety disorder: Persistent anxiety symptoms for > 6 months Symptoms are not due to specific person or situation Commonly starts in the 20s DSM IV Diagnostics Criteria
4. Post traumatic stress disorder (PTSD) & acute stress disorder (ASD): Symptoms occurring after a catastrophic event, serious accident or watching a violent crime or rape etc Symptoms include anxiety, recurrent nightmares, intrusive memories of event PTSD symptoms lasts for > 1 month and can last for years ASD symptoms lasts for 2 – 4 days 5. Phobias (specific / social) In specific phobias, there is irrational fear for some objects like snakes, spiders etc. (specific) In social phobias, there is exaggerated fear for public speaking, using public rest rooms etc As a result of the fear, the person’s avoidance leads to social and occupational problems
ALLOPATHIC METHODSALTERNATIVE METHODS Medications (Drug Therapy): Reduce symptoms: Benzodiazepines -Xanax, Valium Buspirone and Propanolol Behavioral Therapy Cognitive Behavioral Therapy Psychodynamic Psychotherapy: - Gets patients intouch with their feelings Acupuncture Aromatherapy Breathing Exercises Exercise Meditation (calmness and control) Nutrition and Diet Therapy Vitamins Self Love
Cameron was a 35 year old sales manager who's first experience with anxiety occurred at work, in front of his coworkers. He began to feel weak, nauseous, and dizzy and asked a colleague to call a doctor because he was afraid he was having a heart attack since his father had recently died of one. In addition to his personal loss, Cameron was dealing with a lot of stress at work. Several months before his first attack, there were times when he was nervous and had shaky hands, but nothing compared to the attack. He had a physical exam and his doctor told him that it was stress and anxiety. The attacks kept happening, often they were out of the blue and sometimes woke him out of a deep sleep. Cameron felt anxious most of the time because he worried about having another attack. He started to avoid being alone whenever possible. He also avoided certain places, like shopping malls and theaters where he feared being trapped and embarrassed. Cameron’s symptoms are best suited for which criteria? A. Social Anxiety Disorder (SAD) B. Panic Disorder with Agoraphobia C. OCD D. Generalized Anxiety Disorder (GAD) E. Acute Stress Disorder (ASD)
Anxiety Disorders Association of America (ADAA) Fadem, Barbara. (2009). BRS Behavioral Science, Fifth Edition. Lippincott Williams & Wilkins Google images Anxiety (http://www.mayoclinic.org) National Institute of Mental Health (www.nimh.nih.gov) U.S. Dept. of Health & Human Services (http://www.mentalhealth.samhsa.gov/topics/expl ore/stress/) WebMD (http://www.webmd.com/anxiety)